Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology.

Self-care is essential in the long-term management of chronic heart failure. Heart failure guidelines stress the importance of patient education on treatment adherence, lifestyle changes, symptom monitoring and adequate response to possible deterioration. Self-care is related to medical and person-centred outcomes in patients with heart failure such as better quality of life as well as lower mortality and readmission rates. Although guidelines give general direction for self-care advice, health care professionals working with patients with heart failure need more specific recommendations. The aim of the management recommendations in this paper is to provide practical advice for health professionals delivering care to patients with heart failure. Recommendations for nutrition, physical activity, medication adherence, psychological status, sleep, leisure and travel, smoking, immunization and preventing infections, symptom monitoring, and symptom management are consistent with information from guidelines, expert consensus documents, recent evidence and expert opinion

Malaria in the State of Amazonas: a typical Brazilian tropical disease influenced by waves of economic development

In Brazil, more than 99% of malaria cases are reported in the Amazon, and the State of Amazonas accounts for 40% of this total. However, the accumulated experience and challenges in controlling malaria in this region in recent decades have not been reported. Throughout the first economic cycle during the rubber boom (1879 to 1912), malaria was recorded in the entire state, with the highest incidence in the villages near the Madeira River in the Southern part of the State of Amazonas. In the 1970s, during the second economic development cycle, the economy turned to the industrial sector and demanded a large labor force, resulting in a large migratory influx to the capital Manaus. Over time, a gradual increase in malaria transmission was observed in peri-urban areas. In the 1990s, the stimulation of agroforestry, particularly fish farming, led to the formation of permanent Anopheline breeding sites and increased malaria in settlements. The estimation of environmental impacts and the planning of measures to mitigate them, as seen in the construction of the Coari-Manaus gas pipeline, proved effective. Considering the changes occurred since the Amsterdam Conference in 1992, disease control has been based on early diagnosis and treatment, but the development of parasites that are resistant to major antimalarial drugs in Brazilian Amazon has posed a new challenge. Despite the decreased lethality and the gradual decrease in the number of malaria cases, disease elimination, which should be associated with government programs for economic development in the region, continues to be a challenge

Assessment of frailty in patients with heart failure: A new Heart Failure Frailty Score developed by Delphi consensus.

AIMS: The Heart Failure Frailty Score (HFFS) is a novel, multidimensional tool to assess frailty in patients with heart failure (HF). It has been developed to overcome limitations of existing frailty assessment tools while being practical for clinical use. The HFFS reflects the concept of frailty as a multidimensional, dynamic and potentially reversible state, which increases vulnerability to stressors and risk of poor outcomes in patients with HF. METHODS AND RESULTS: The HFFS was developed through a Delphi consensus process involving 54 international experts. This approach involved iterative rounds of questionnaires and interviews, where a panel of experts provided their opinions on specific questions prepared by the Steering Committee. The experts were invited to vote and share their views anonymously, using a 5-point Likert scale over iterative rounds. An 80% threshold was set for agreement or disagreement for each statement. Twenty-two variables from four domains (clinical, functional, psycho-cognitive and social) have been selected for inclusion in the HFFS after the third round of the Delphi process. A shorter version (S-HFFS), including 10 variables, has also been developed for daily clinical use. CONCLUSIONS: The HFFS is a new multidimensional tool for the identification of frailty in patients with HF. It should also enables healthcare providers to identify potential 'red flags' for frailty in order to develop personalized care plans. The next step will be to validate the new score in patients with HF

The genome sequence of the plant pathogen Xylella fastidiosa

Xylella fastidiosa is a fastidious, xylem-limited bacterium that causes a range of economically important plant diseases. Here we report the complete genome sequence of X. fastidiosa clone 9a5c, which causes citrus variegated chlorosis-a serious disease of orange trees. The genome comprises a 52.7% GC-rich 2,679,305-base-pair (bp) circular chromosome and two plasmids of 51,158 bp and 1,285 bp. We can assign putative functions to 47% of the 2,904 predicted coding regions. Efficient metabolic functions are predicted, with sugars as the principal energy and carbon source, supporting existence in the nutrient-poor xylem sap. The mechanisms associated with pathogenicity and virulence involve toxins, antibiotics and ion sequestration systems, as well as bacterium-bacterium and bacterium-host interactions mediated by a range of proteins. Orthologues of some of these proteins have only been identified in animal and human pathogens; their presence in X. fastidiosa indicates that the molecular basis for bacterial pathogenicity is both conserved and independent of host. At least 83 genes are bacteriophage-derived and include virulence-associated genes from other bacteria, providing direct evidence of phage-mediated horizontal gene transfer.Univ Estadual Campinas, Inst Computacao, BR-13083970 Campinas, SP, BrazilInst Ludwig Pesquisa Canc, BR-01509010 Sao Paulo, BrazilUniv Sao Paulo, Inst Quim, Dept Bioquim, BR-05508900 Sao Paulo, BrazilUniv Estadual Campinas, Ctr Biol Mol & Engn Genet, BR-13083970 Campinas, SP, BrazilUniv Sao Paulo, Fac Med Vet & Zootecnia, Dept Patol, Mol Biol Lab, BR-05508000 Sao Paulo, BrazilUniv Sao Paulo, Fac Med, Dept Radiol, Disciplina Oncol, BR-01296903 Sao Paulo, BrazilUniv Estadual Paulista, Fac Ciencias Agr & Vet Jaboticabal, Dept Tecnol, BR-14884900 Jaboticabal, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Microbiol Imunol & Parasitol, BR-04023062 Sao Paulo, BrazilUniv Sao Paulo, Inst Ciencias Biomed, Dept Microbiol, BR-05508900 Sao Paulo, BrazilUniv Estadual Campinas, Fac Ciencias Med, Hemoctr, BR-13083970 Campinas, SP, BrazilINRA, F-33883 Vilenave Dornon, FranceUniv Bordeaux 2, Biol Cellulaire & Mol Lab, F-33883 Vilenave Dornon, FranceUniv Sao Paulo, Inst Biociencias, Dept Biol, BR-05508900 Sao Paulo, BrazilUniv Sao Paulo, Escola Super Agr Luiz de Queiroz, BR-13418900 Piracicaba, SP, BrazilUniv Estadual Paulista, Inst Biociencias, Dept Genet, BR-18618000 Botucatu, SP, BrazilInst Agron Campinas, Ctr Genet Biol Mol & Fitoquim, BR-13001970 Campinas, SP, BrazilUniv Sao Paulo, Fac Med Ribeirao Preto, Dept Clin Med, BR-14049900 Ribeirao Preto, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Biofis, BR-04023062 Sao Paulo, BrazilInst Agron Campinas, Ctr Citricultura Sylvio Moreira, BR-13490970 Cordeiropolis, SP, BrazilInst Biol, Lab Bioquim Fitopatol, BR-04014002 Sao Paulo, BrazilInst Biol, Lab Imunol, BR-04014002 Sao Paulo, BrazilUniv Ribeirao Preto, Dept Biotecnol Plantas Med, BR-14096380 Ribeirao Preto, SP, BrazilUniv Sao Paulo, Ctr Energia Nucl Agr, BR-13400970 Piracicaba, SP, BrazilDeutsch Krebsforschungszentrum, D-69120 Heidelberg, GermanyUniv Estadual Paulista, Fac Med Vet & Zootecnia, Dept Melhoramento & Nutr, BR-18600000 Botucatu, SP, BrazilUniv Sao Paulo, Fac Ciencias Farmaceut Ribeirao Preto, Dept Ciencias Farmaceut, BR-14040903 Ribeirao Preto, SP, BrazilUniv Sao Paulo, Fac Filosofia Ciencias & Letras Ribeirao Pret, Dept Biol, BR-14040901 Ribeirao Preto, SP, BrazilInst Butantan, Ctr Biotecnol, BR-05503900 Sao Paulo, BrazilUniv Sao Paulo, Fac Med, Inst Coracao, Lab Genet & Cardiol Mol LIM 13, BR-05403000 Sao Paulo, BrazilUniv Estadual Paulista, Fac Ciencias Agron, Dept Prod Vegetal, BR-18603970 Botucatu, SP, BrazilUniv Estadual Paulista, Fac Ciencias Agr & Vet Jaboticabal, Dept Biol Aplicada Agropecuaria, BR-14884900 Jaboticabal, SP, BrazilHosp Canc AC Camargo, BR-01509010 Sao Paulo, BrazilUniv Mogi das Cruzes, Nucleo Integrado Biotecnol, BR-08780911 Mogi Das Cruzes, SP, BrazilUniv Estadual Campinas, Inst Biol, Dept Genet & Evolucao, BR-13083970 Campinas, SP, BrazilUniv Sao Paulo, Inst Biociencias, Dept Bot, BR-05508900 Sao Paulo, BrazilUniv Sao Paulo, Fac Med Ribeirao Preto, Dept Parasitol Microbiol & Imunol, BR-14049900 Ribeirao Preto, SP, BrazilUniv Sao Paulo, Fac Med, Inst Psiquiatria, Dept Psiquiatria, BR-05403010 Sao Paulo, BrazilUniv Vale Paraiba, Sao Jose dos Campos, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Microbiol Imunol & Parasitol, BR-04023062 Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Biofis, BR-04023062 Sao Paulo, BrazilWeb of Scienc

The BABAR detector

BABAR, the detector for the SLAC PEP-II asymmetric e(+)e(-) B Factory operating at the Y(4S) resonance, was designed to allow comprehensive studies of CP-violation in B-meson decays. Charged particle tracks are measured in a multi-layer silicon vertex tracker surrounded by a cylindrical wire drift chamber. Electromagnetic showers from electrons and photons are detected in an array of CsI crystals located just inside the solenoidal coil of a superconducting magnet. Muons and neutral hadrons are identified by arrays of resistive plate chambers inserted into gaps in the steel flux return of the magnet. Charged hadrons are identified by dE/dx measurements in the tracking detectors and by a ring-imaging Cherenkov detector surrounding the drift chamber. The trigger, data acquisition and data-monitoring systems, VME- and network-based, are controlled by custom-designed online software. Details of the layout and performance of the detector components and their associated electronics and software are presented